April 2008 Criminal Enforcement Report

Archive Criminal Enforcement Archive

Durable Medical Equipment

In Texas, the owner of a medical equipment supplier was sentenced to 24 months in prison and ordered to pay $4.4 million in restitution for her role in a health care fraud kickback scheme. The woman paid runners between $800 and $1,000 for each certificate of medical necessity (CMN) that physicians signed. She then used the fraudulent CMNs to bill Medicare and Medicaid for power wheelchairs provided to beneficiaries that were not medically necessary.

Transportation Fraud

In Washington, D.C., the owner of a non-emergency transportation company was sentenced to 1 year and 1 day in prison, 6 months home detention and ordered to forfeit over $211,000 for health care fraud. The man billed Medicaid for 6,660 transportation services for D.C. Medicaid recipients that were not provided.

Other Cases of Interest

In Ohio, a man was sentenced to 2 years imprisonment and ordered to pay $155,000 in restitution, including over $94,000 to Medicaid, for aggravated identity theft. The investigation revealed that the man stole the identity of a Texas Medicare beneficiary more than 20 years ago and began using the identity in 1998 to obtain Medicaid and public assistance benefits. In 2004, the man began using the identity to obtain services covered by Medicare including an extended stay in a skilled nursing facility and for wound care services that he received while living in a homeless shelter for which Medicare paid over $61,000.

Medicaid Fraud

In New Jersey, a pharmacy owner was sentenced to 5 months in prison, 5 months in home detention and ordered to pay a $5,000 fine for adulteration of drugs and filing a false tax return. The man, who owned several pharmacies in New Jersey, billed Medicaid for prescription drugs provided to beneficiaries that were obtained on the black market from illicit sources. He also used his pharmacies to launder money and to transfer funds out of the country.

Child Support Enforcement

In Indiana, a man was sentenced to 8 years incarceration with 4 years suspended, 4 years probation and ordered to pay over $58,000 in restitution for failure to pay child support. The man, who was residing in Kentucky, was arrested in October 2007 and subsequently pled guilty to 2 counts of failure to pay child support.

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